Epigastric Pain

Question 1

Epigastric Pain

Western Medical Diagnosis

8 Points

Answer 1

• carcinoma of esophagus
• gastritis
• gastric ulcer
• carcinoma of ST
• duodenal ulcer
• pancreatitis
• cancer of pacreas
• gall stones

Question 2

Red Flags

Perforated Gastric Ulcer

3 Points

Answer 2

• sever pain spreading over abdomen
• reluctant to move
• ‘don’t touch me’

Question 3

Red Flags

Actue Pancreatitis

2 Points

Answer 3

• pain relieved by sitting up and leaning forward
• pain radiates to back

Question 4

Red Flags

Epigastric Pain

3 points

Answer 4

• vomitting blood
• Severe pain
• balck stool looks like coffee grinds

Question 5

Nature of pain

Severe

Answer 5

Excess

Question 6

Nature of pain:

Dull

Answer 6

Deficiency

Question 7

Nature of pain:

Stabbing

Answer 7

Blood Stasis

Question 8

Nature of pain:

Burning

Answer 8

Heat

Question 9

Nature of pain:

Feeling of fullness

Answer 9

Dampness

Question 10

Nature of pain:

Morning Pain

Answer 10

Deficiency

Question 11

Nature of pain:

Afternoon Pain

Answer 11

Qi Stagnation

Question 12

Nature of pain:

Pain at Night

Answer 12

Blood stasis

Question 13

Aggravating / Alleviating Factors:

Better after eating =
Worse after eating =

Answer 13

Deficiency
Excess

Question 14

Aggravating / Alleviating Factors:

Better with pressure =
Worse with pressure =

Answer 14

Deficiency
Excess

Question 15

Aggravating / Alleviating Factors:

Better with heat =

Answer 15

Cold

Question 16

Aggravating / Alleviating Factors:

Better with rest =
Better with slight exercise =

Answer 16

Deficiency
Qi and Blood stagnation

Question 17

Aggravating / Alleviating Factors:

Better after vomitting =
Worse after vomitting =

Answer 17

Excess
Deficiency

Question 18

Taste:

Sticky =
Bitter =
Sweet =
Sour =
No taste =

Answer 18

Dampness
Heat
Damp - Heat
Food Retention
Sp Deficiency

Question 19

Etiology:

Blockage in ST
                               ↙️↘️
               (6)Excess         Deficient (2)

What are the 6 Excess Conditions?

Answer 19

Blood Stasis
Phlegm Fluids
Food Retention
Cold
LR over acting ST
Fire / Damp Heat / Phlegm - Fire

Question 20

Etiology:

Blockage in ST
                               ↙️↘️
               (6)Excess         Deficient (2)

What are the 2 Deficient Conditions?

Answer 20

Yin XU
Yang XU

Question 21

Patient was exposed to cold and or eats raw food and smoothies:

Acute, severe, sudden onset. Epigastric pain, worse with cold, better with heat.

What Excess Pattern do they have?

6 Points

Answer 21

ST21, ST34, CV12, PC6, SP4, Moxa

Cold invading the ST

Cold obstruct flow of ST qi and prevent it from discending

Question 22

Patient was hungry at lunch, consumed his lunch and his friends too.

Distension pain, fullness of epi and ab. Foul gas / breath with acid reflux.

What Excess Pattern do they have?

6 Points

Answer 22

Lineiting, ST44, ST21, CV10, PC6, ST36

Retention of Food

Discending of ST Qi is impared/ stagnant

Question 23

Patient’s a high powered lawyer who eats on the go, often while standing

Epigastric pain, distension radiating to hypochondrium, onset associated with emotional stress.

What Excess Pattern do they have?

6 Points

Answer 23

LR14, CV12, GB34, PC6, ST36, LR3

LR Qi invading ST

Stress/Anxiety impairs fx of LR. LR over acts on ST, Qi flow is obstructed.

Question 24

Patient eats spicy lamb dishes. Home life is busy and he rages sometimes

Burning epigastric pain, bleeding gums, vomitting blood, thrist, sour regurgitation, constipation.

What Excess pattern do they have?

5 Points

Answer 24

ST44, ST21, SP6, CV13, BL21

ST Fire

Heat is drying digestive tract and pushing blood out of vessels.

Question 25

# Pateint eats one large meal a day an prefers deepfried food with spice Feeling of oppression in epigastrium, burning pain, dry mouth, no desire to drink, mucus in stool, red face, manic behavior, mouth ulcers. | What Excess pattern does he have? ## Footnote 5 Points

Answer 25

CV12, ST44, ST40, ST21, PC7 | ST Phlegm Fire ## Footnote Phlegm fire is caused by qi stagnation turning to heat with the addition of dampness from diet or constiution

Question 26

# Patient enjoyes drinks with friends after work to de stress Dull epigastric pain, dry mouth with no desire to drink, bitter sticky taste in mouth, frontal headache, oppression in the chest. | What Excess pattern do they have? ## Footnote 6 points

Answer 26

BL20, SP9, BL21, SP6, CV12, ST21 | ST Damp Heat ## Footnote stress and diet can cause qi to stagnate gathering dampness and turning to heat.

Question 27

# Patient plays baseball and got hit in the stomach with a pitch Stabbing pain with fixed location in epigastrum, vomitting blood, black stools. | What Excess pattern do they have? ## Footnote 8 Points

Answer 27

CV12, ST36, PC6, SP4, ST21, ST34, SP10, BL17 | Blood stasis in ST ## Footnote blunt trauma to abdomin may have caused internal bleed causing qi and blood stasis.

Question 28

# Patient has always felt cold and does not warm easily. Dull indistinct ST pain, increases in pain when stomach is empty, regurgitation of clear fluids, pain improves with pressure | What Deficiency Pattern do they have? ## Footnote 8 Points

Answer 28

BL20, BL21, CV12, CV6, ST36, PC6, SP4, Moxa | ST and SP yang xu ## Footnote yang xu is deficiency of organ fx. Can be from constitution, EPI or diet.

Question 29

# Patient was taking prescription drugs for over 3 months Has dry mouth, with desire to drink little sips, dry throat, dull epigastric pain, feeling of heat with mental restlessness and dry stool | What deficiency pattern do they have? ## Footnote 6 Points

Answer 29

BL20, BL21, CV12, ST, 36, SP6, KD3 | Stomach Yin XU ## Footnote Pharmasutical drugs can damage ST yin, can also be from diet, stress or EPI

Question 30

# Etiology Eipgastric Pain ## Footnote 6 Points

Answer 30

EPI Diet Emotional Problems Over exertion / Overwork Consitiutional Weakness Wrong treatment